Residual Injurious Symptoms and Its Association With Neurodegenerative Outcomes in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Retrospective, Longitudinal <scp>Follow‐up</scp> Study

Wang, Jing; Liu, Yaping; Chau, Chi-Kin; Zhang, Jihui; Tsang, Jessie CC.; Yu, Manda; Chan, Ngan Yin; Chan, Joey Wy; Li, Shirley Xin; Huang, Bei; Feng, Hongliang; Mok, Vincent; Wing, Yun Kwok

doi:10.1002/mds.28210

Cited by 6 publications

(5 citation statements)

References 40 publications

(97 reference statements)

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“…The major limitation of this study was the diagnostic issue for the piRBD group. Although RBDQ-HK has high internal consistency and test–retest reliability to screen piRBDs in China (sensitivity = 82.2%, specificity = 86.9%, positive predictive value = 86.3%, and negative predictive value = 83.0% 50 , 51 ), considering the absence of comprehensive neuropsychological tests and the substantial difference in MoCA scores, especially in patients with piRBD, early-stage dementia with Lewy bodies without parkinsonism may be included in the piRBD group. In the future, we plan to follow-up on these piRBDs in a longitudinal cohort study to further corroborate the current findings.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson’s disease

Guo

Wang

et al. 2022

npj Parkinsons Dis.

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Alpha-synucleinopathy is postulated to be central to both idiopathic rapid eye movement sleep behaviour disorder (iRBD) and Parkinson’s disease (PD). Growing evidence suggests an association between the diminished clearance of α-synuclein and glymphatic system dysfunction. However, evidence accumulating primarily based on clinical data to support glymphatic system dysfunction in patients with iRBD and PD is currently insufficient. This study aimed to use diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system activity and its relationship to clinical scores of disease severity in patients with possible iRBD (piRBDs) and those with PD. Further, we validated the correlation between the ALPS index and the prognosis of PD longitudinally. Overall, 168 patients with PD, 119 piRBDs, and 129 healthy controls were enroled. Among them, 50 patients with PD had been longitudinally reexamined. Patients with PD exhibited a lower ALPS index than those with piRBDs (P = 0.036), and both patient groups showed a lower ALPS index than healthy controls (P < 0.001 and P = 0.001). The ALPS index and elevated disease severity were negatively correlated in the piRBD and PD subgroups. Moreover, the ALPS index was correlated with cognitive decline in patients with PD in the longitudinal analyses. In conclusion, DTI-ALPS provided neuroimaging evidence of glymphatic system dysfunction in piRBDs and patients with PD; however, the potential of assessing the pathological progress of α-synucleinopathies as an indicator is worth verifying. Further development of imaging methods for glymphatic system function is also warranted.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson’s disease

Guo

Wang

et al. 2022

npj Parkinsons Dis.

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“…Nonetheless, our previous longitudinal study found that clonazepam did not influence the REM sleep EMG level at nearly 2 and a half years of follow-up. 43,50 In addition, the observation of REM sleep behavioral event was not rater-blind, and a potential bias might exist that technicians might not have paid much attention to REM sleep behavioral events among controls. It should be noted that there was a high variability of REM sleep behavioral events between 2 nights video-PSG recording.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Prodromal REM Sleep Behavior Disorder to Neurodegeneration

et al. 2022

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Background and Objectives:Individuals with a history of recurrent dream-enactment behaviors, but with subthreshold REM sleep without atonia levels for REM sleep behavior disorder (RBD) diagnosis, are currently classified to have prodromal RBD (pRBD). However, the REM sleep elevated EMG diagnostic cut-off, progression trajectory, and long-term neurodegenerative outcome of pRBD are not well understood. This study aimed to delineate the evolution of REM sleep EMG levels, determine the EMG cut-off score for diagnosing pRBD, and examine the risk for neurodegenerative diseases of pRBD.Methods:This retrospective longitudinal case-control study recruited pRBD patients and age, sex, and follow-up duration matched controls who were free of neurodegenerative disease at baseline in the Sleep Assessment Unit, the Chinese University of Hong Kong from 1997 to 2018. Patients and controls underwent clinical and video-polysomnography assessments at baseline and follow-up(s). REM sleep EMG activity level on mentalis and anterior tibialis (AT) muscles on video-polysomnography at each visit was scored. The diagnosis of neurodegenerative diseases was confirmed by a neurologist.Results:44 patients (67.4 ± 8.2 years old, 6 females) and 44 controls were recruited. The combined REM sleep EMG level on mentalis and AT muscles of pRBD patients significantly increased during 8.2 ± 3.3 years of follow-up (from 19.3 ± 9.7% to 47.3 ± 27.4% with estimated annual increase of 3.9%), yielding 29 pRBD patients (66%) meeting the full-blown RBD diagnostic criteria. Baseline REM sleep mentalis and AT muscles EMG activity of patients who developed full-blown RBD could favourably differentiate pRBD from controls (6.3% for mentalis ‘any’ and 9.1% for combination of mentalis ‘any’ and bilateral AT muscles phasic EMG with AUC of 0.88 [0.78-0.98] and 0.97 [0.92-1.00] respectively). pRBD patients had a higher risk for neurodegenerative diseases (9 developed Parkinson’s disease and 3 developed dementia with Lewy bodies) when compared to controls (5 developed Alzheimer’s disease, adjusted hazard ratio = 2.95, 95% CI = 1.02-8.54).Conclusions:pRBD has a predictive progression in both pathophysiology and neurodegenerative outcome. This finding has significant implications to the nosological status of pRBD, the current REM sleep-related EMG diagnostic criteria, spectrum concept of RBD and future neuroprotective intervention.Classification of Evidence:This study provides Class III evidence that EMG activity during REM sleep predicts the development of prodromal REM sleep behavior disorder.

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“…22 DEBs were evaluated by the Diagnostic Interview for Sleep Patterns and Sleep Disorders and supplemented by the RBD questionnaire-Hong Kong (factor 2 score ≥8). 23,24 Lifetime psychiatric disorders were assessed via a structured interview based on the DSM-IV and further supplemented by clinical records. 25,26 Current medications usage, including antidepressants, antipsychotics, and antiepileptics, were collected during the interview and supplemented by clinical records.…”

Section: Methodsmentioning

confidence: 99%

“…DEBs were evaluated by the Diagnostic Interview for Sleep Patterns and Sleep Disorders and supplemented by the RBD questionnaire‐Hong Kong (factor 2 score ≥8) 23,24 . Lifetime psychiatric disorders were assessed via a structured interview based on the DSM‐IV and further supplemented by clinical records 25,26 .…”

Section: Methodsmentioning

confidence: 99%

Altered Impulsivity Across Drug‐Naïve Parkinsonism, Isolated Rapid Eye Movement Sleep Behavior Disorder, and Their High‐Risk Relatives

Zhou,

Li,

Chau

et al. 2024

Annals of Neurology

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ObjectiveTo determine multidimensional impulsivity levels across different early stages of α‐synucleinopathy.MethodsThis cross‐sectional study investigated motor and decisional impulsivity levels using a panel of computerized tasks among drug‐naïve parkinsonism patients, isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) patients and their first‐degree relatives (iRBD‐FDRs), and control subjects. Trait impulsivity and impulse control behaviors were assessed by self‐reported questionnaires.ResultsA total of 27 drug‐naïve parkinsonism patients, 157 iRBD patients, 66 iRBD‐FDRs, and 82 control subjects were recruited. Parkinsonism and iRBD patients had fewer numbers of extracted beads in beads task 1 and 2 (both P < 0.001) and higher rate of irrational choice in task 1 (P = 0.046) before making decisions, and fewer numbers of pumps of unexploded blue balloons in balloon analogue risk task (P = 0.004) than control subjects, indicating a higher level of reflection impulsivity and a lower level of risk taking, respectively. iRBD patients had more no‐go errors in go/no‐go task than control subjects (Padjusted = 0.036), suggesting a higher level of motor impulsivity. iRBD‐FDRs with dream‐enactment behaviors (DEBs) had fewer numbers of extracted beads (P = 0.047) in beads task 2 than FDRs without DEBs, suggesting a possible higher level of reflection impulsivity.InterpretationA complex construct of altered impulsivity with decreased risk taking but increased reflection and motor impulsivity has already occurred at the prodromal and early stages of α‐synucleinopathy, which have implications for underlying pathophysiology and clinical management of α‐synucleinopathy, especially for impulse control behaviors upon dopaminergic drug treatment.This article is protected by copyright. All rights reserved.

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Residual Injurious Symptoms and Its Association With Neurodegenerative Outcomes in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Retrospective, Longitudinal Follow‐up Study

Cited by 6 publications

References 40 publications

Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson’s disease

Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson’s disease

Evolution of Prodromal REM Sleep Behavior Disorder to Neurodegeneration

Altered Impulsivity Across Drug‐Naïve Parkinsonism, Isolated Rapid Eye Movement Sleep Behavior Disorder, and Their High‐Risk Relatives

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